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Does autonomic dysfunction in cirrhosis liver influence variceal bleed?

Joye Varghese S, Balan N, Naveen B, Caroline Selvi K, Jayapalan K, Jayanthi V

Abstract

Background: Autonomic dysfunction has been documented in cirrhosis liver. Its influence on variceal bleed is not known. Aim: To determine the autonomic function amongst variceal bleeders in cirrhosis of the liver. Materials and methods: Fifty cirrhotics (variceal bleeders: 34) belonging to either sex, Childs B, age more than 15 years and non diabetic constituted the study group. Parasympathetic function tests included valsalva ratio (E:I ratio) and deep breathing test. (Max.-Min. heart rate); sympathetic function included postural fall of B.P and a rise in diastolic B.P. with sustained hand grip. A cirrhotic was considered to have 'True' autonomic dysfunction when both parasympathetic and one of the two sympathetic tests were abnormal. Results: The mean age for men was 39.64 + 10.6 yrs and for women 39.54 + 15.8 yrs. The male female ratio was 3.5:1. Only 10 of the 50 patients (all bleeders) had 'true' autonomic dysfunction i.e. 20%. Parasympathetic dysfunction alone was positive in 19 (38%) and sympathetic in 10 patients (20%). The E:I ratio (p < 0.001) and an increase in diastolic B.P. during sustained hand grip (p < 0.04) were significantly positive amongst variceal bleeders. Conclusion: 'True' autonomic dysfunction can predispose a cirrhotic to variceal bleed.

Key words. Cirrhosis, variceal bleeders, autonomic dysfunction

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The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for the Study of the Liver and the Canadian Association for the Study of the Liver

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